The purpose of this study is to understand the clinical impact of non-surgical and surgical treatment in atrial fibrillation induced tricuspid regurgitation (AFTR).

Inclusion Criteria:

• Age ≥ 18 years.
• Moderate-severe or severe TR while in atrial fibrillation.
• Ambulatory (not wheelchair/scooter dependent).

Exclusion Criteria:

• Systolic pulmonary artery pressure>70 mmHg with a fixed pulmonary vascular resistance >7 Wood units by catheterization.
• Ejection fraction <40%.
• Obstructive hypertrophic cardiomyopathy.
• Constrictive pericarditis or tamponade.
• Active myocarditis.
• Complex congenital heart disease.
• Other valve disease requiring surgical intervention.
• Terminal illness (other than HF) with expected survival of less than 1 year.
• Pregnancy or breastfeeding mothers.